Ch. 38 PrepU
A nurse visits the employee health department because of mild itching and a rash on both hands. During the assessment interview, the employee health nurse should focus on: chemical and latex glove use. medication allergies. laundry detergent or bath soap changes. life stressors the nurse may be experiencing.
chemical and latex glove use.
A client reports to a physician's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education? "I'll go directly to the pharmacy with my EpiPen prescription." "The test may be mildly uncomfortable." "If I notice tingling in my lips or mouth, gargling may help the symptoms." "I may experience itching and irritation at the site of the testing."
"If I notice tingling in my lips or mouth, gargling may help the symptoms."
A patient received epinephrine in response to an anaphylactic reaction at 10:00 AM. The nurse knows to observe the patient for a "rebound" reaction that may occur as early as: 6:00 PM. 2:00 PM. 4:00 PM. 10:00 PM.
2:00 PM.
Which of the following would the nurse prioritize as the most important action for the patient to take to prevent anaphylaxis? Desensitization Carry an emergency kit Avoid potential allergens Wear a medical alert bracelet
Avoid potential allergens
Histamine release in anaphylaxis causes which of the following? Nasal congestion Feeling of impending doom Urinary urgency Stomach cramps
Nasal congestion
A nurse is preparing a presentation to a local commununity group about allergic disorders. Which medication would the nurse include as the most common cause of anaphylaxis? a)Penicillin b)Iodine contrast agent c) Morphine d) Aspirin
Penicillin Explanation: Although aspirin, morphine (an opioid) and radiocontrast agents such as iodine can cause anaphylaxis, penicillin is the most comon cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States each year.
Which of the following interventions is the single most important aspect for the patient at risk for anaphylaxis? Use of antihistamines Wearing of medical alert bracelet Prevention Desensitization
Prevention
The nurse is conducting a community education program on allergies and anaphylactic reactions. The nurse determines that the participants understand the education when they make which of the following statements about anaphylaxis? Systemic reactions include urticaria and angioedema. Anaphylactoid (anaphylaxislike) reactions are commonly fatal. The most common food item causing anaphylaxis is chocolate. The most common cause of anaphylaxis is penicillin.
The most common cause of anaphylaxis is penicillin.
Which of the following statements describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex? They occur within minutes after exposure to latex. They may worsen when hand lotion is applied before donning latex gloves. They can be eliminated by changing glove brands or using powder-free gloves. They are localized to the area of exposure, usually the back of the hands.
They are localized to the area of exposure, usually the back of the hands.
A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in her teaching plan? Keep the thermostat above 75° F (23.9° C). Wear only synthetic fabrics. Bathe only three times per week. Use a topical skin moisturizer daily.
Use a topical skin moisturizer daily. Explanation: The nurse should instruct the client to use a topical skin moisturizer daily to help keep the skin hydrated. Likewise, the client should be encouraged to bathe daily. To minimize irritation, the client should wear only cotton fabrics. The client should maintain a room temperature between 68° F (20° C) and 72° F (22.2° C).
A client is scheduled to begin immunotherapy. The nurse would explain that the client will receive injections initially at which interval Monthly Weekly Daily Bi-monthly
Weekly
After teaching a client how to self-administer epinephrine, the nurse determines that the teaching plan has been successful when the client demonstrates which of the following? a)Maintains pressure on the auto-injector for about 30 seconds after insertion b)Jabs the autoinjector into the outer thigh at a 90-degree angle c) Avoids massaging the injection site after administration d)Pushes down on the grey release cap to administer the medication
Jabs the autoinjector into the outer thigh at a 90-degree angle Explanation: To self-administer epinephrine, the client should remove the autoinjector from its carrying tube, grasp the unit with the black tip (injectiing end) pointed downward, form a fist around the device, and remove the gray safety release cap. Then the client should hold the black tip near the outer thigh and swing and jab firmly into the outer thigh at a 90-degree angle until a click is heard. Next, the client should hold the device firmly in place for about 10 seconds, remove the device, and massage the site for about 10 seconds.
Nursing students are reviewing various medications that can be used to treat allergic disorders. The students demonstrate understanding of the information when they identify which of the following as an intranasal corticosteroid? a)Fexofenadine b)Fluticasone c)Zileuton d)Cromolyn sodium
Fluticasone Explanation: Fluticasone is an example of an intranasal corticosteroid. Cromolyn sodium is a mast cell stabilizer. Zileuton is a leukotriene-receptor inhibitor. Fexofenadine is a second-generation antihistamine.
A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch. The nurse is aware that the patient may be having an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure? 6 hours 12 hours 24 hours 2 hours
2 hours
A patient was seen in the clinic 3 days previously for allergic rhinitis and was given a prescription for a corticosteroid nasal spray. The patient calls the clinic and tells the nurse that the nasal spray is not working. What is the best response by the nurse? "I am sorry that you are feeling poorly but this is the only medication that will work for your problem." "The full benefit of the medication may take up to 2 weeks to be achieved." "You may be immune to the effects of this medication and will need something else in its place." "You need to come back to the clinic to get a different medication since this one is not working for you."
"The full benefit of the medication may take up to 2 weeks to be achieved."
While monitoring the patient's eosinophil level, the nurse suspects a definite allergic disorder when seeing an eosinophil value of what percentage of the total leukocyte count? 3% to 4% 5% to 10% 15% to 40% 1% to 3%
15% to 40%
Which type of contact dermatitis requires light exposure in addition to allergen contact? Allergic Irritant Phototoxic Photoallergic
Photoallergic
Which of the following body substances causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? Serotonin Prostaglandin Bradykinin Histamine
Histamine
The nurse teaches the patient with allergies about anaphylaxis including which of the following statements? Anaphylactoid (anaphylaxis-like) reactions are commonly fatal. The most common cause of anaphylaxis is penicillin. The most common food item causing anaphylaxis is chocolate. Systemic reactions include urticaria and angioedema.
The most common cause of anaphylaxis is penicillin.
What education should the nurse provide to the patient taking long-term corticosteroids? Corticosteroids are relatively safe drugs with very few side effects. The patient should take the medication only as needed and not take it unnecessarily. The patient should not stop taking the medication abruptly and should be weaned off of the medication. The patient should discontinue using the drug immediately if weight gain is observed.
The patient should not stop taking the medication abruptly and should be weaned off of the medication.
The nurse practitioner treating a patient with allergic rhinitis decides pharmacologic therapy would be helpful. Which of the following is she most likely to prescribe? Rhinocort Sudafed Allegra Afrin
Allegra
A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? "It means you are very sensitive to something inside of yourself." "It is a harmless reaction to something in the environment." "It is a muted response to something in the environment." "It is a hyperimmune response to something in the environment that is usually harmless."
"It is a hyperimmune response to something in the environment that is usually harmless."
The nurse is administering a sympathomimetic drug to a patient. What areas of concern does the nurse have when administering this drug? (Select all that apply.) Constricts integumentary smooth muscle Causes laryngospasm Causes bronchoconstriction Dilates the muscular vasculature Causes bronchodilation
Causes bronchodilation Constricts integumentary smooth muscle Dilates the muscular vasculature
Injected allergens are used for "hyposensitization" and may produce systemic reactions that can be harmful. Which of the following medications should be on hand in case of an adverse reaction? Epinephrine Pyribenzamine Phenergan hydrochloride Dramamine
Epinephrine Explanation: Although severe systemic reactions occur in less than 1% of patients, the risk for potentially fatal anaphylaxis exists. It tends to occur at the beginning of the treatment cycle. Because of this risk, epinephrine should be immediately available.
A patient with a history of anaphylactic reactions to insect stings has just been stung by a wasp. The patient is going to self-administer his EpiPen. Place the steps in the correct order that he would follow. Use all options. 1 Call the emergency medical response number (911) 2 Remove the gray safety-release cap 3 Jab the black tip into the outer thigh 4 Massage the injection area
Remove the gray safety-release cap Jab the black tip into the outer thigh Massage the injection area Call the emergency medical response number (911)
A client being treated for an allergy has been prescribed antihistamines. The Kardex of this client reads as follows: Age: 32; Profession: Carpenter; Lifestyle & diet: Lives alone, average smoker, nonalcoholic, no food preferences, practices yoga; Medical history: Suffers from hay fever, recent urinary tract infection that has been treated successfully. What information from the Kardex is likely to have the greatest implication in educating the client about antihistamine administration? The client's age The client's medical history The client's smoking habit The client's profession
The client's profession
Which of the following is a contraindication for immunotherapy? Allergic asthma Allergic rhinitis Conjunctivitis Use of a beta-blocker
Use of a beta-blocker
The best treatment for latex allergy includes which of the following? Emergency kit with epinephrine Antihistamines Avoidance of latex-based products Corticosteroids
Avoidance of latex-based products
A patient with a history of allergies comes to the clinic for an evaluation. The following laboratory test findings are recorded in a patient's medical record: Total serum IgE levels: 2.8 mg/mL White blood cell count: 5,100/cu mm Eosinophil count: 4% Erythrocyte sedimentation rate: 20 mm/h The nurse identifies which result as suggesting an allergic reaction? Serum IgE level Erythrocyte sedimentation rate White blood cell count Eosinophil count
Serum IgE level
The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? a)Ranitidine (Zantac) b)Diphenhydramine (Benadryl) c)Omeprazole (Prilosec) d) Cimetidine (Tagamet)
Diphenhydramine (Benadryl) Explanation: Certain medications are categorized by their action at these receptors. Diphenhydramine (Benadryl) is an example of an antihistamine, a medication that displays an affinity for H1 receptors. Cimetidine (Tagamet) and ranitidine (Zantac) target H2 receptors to inhibit gastric secretions in peptic ulcer disease.
A nurse practitioner working in an allergy clinic is treating a patient who is allergic to ragweed. She advises the patient to expect an increase in symptoms during which of the following seasons? Early fall Late spring Early summer Early spring
Early fall Explanation: Ragweed has a seasonal occurrence in early fall. Tree pollen and mold spores occur in the spring. Rose and grass pollen occur in the summer.
A client is receiving immunotherapy as part of the treatment plan for an allergic disorder. After administering the therapy, the client states, "I guess I can go home now." Which response by the nurse would be most appropriate? a) "You need to stay about another half-hour so we can make sure you don't have a reaction." b)"It's okay to leave but make sure to call us if you start to feel strange after an hour or so." c) "You must stay here so that you can get another injection of a different substance to which you're allergic." d)"We need to schedule your next appointment first and then you can leave."
"You need to stay about another half-hour so we can make sure you don't have a reaction." Explanation: Although severe systemic reactions are rare, the risk of serious and potentially fatal anaphylaxis exists. Therefore, the client needs to remain in the office or clinic for at least 30 minutes after the injection to be observed for possible systemic symptoms. The client should not be allowed to leave until 30 minutes pass. If more than one allergen is being used, the injections typically occur at the same time.
The nurse observes diffuse swelling involving the deeper skin layers in a patient who has experienced an allergic reaction. The nurse would correctly document this finding as which of the following? Angioneurotic edema Pitting edema Urticaria Contact dermatitis
Angioneurotic edema
A nurse comes to the employee health center for evaluation and is diagnosed with allergic contact dermatitis related to latex. Which of the following would the nurse most likely exhibit? Rhinitis Angioedema Blistering Laryngeal edema
Blistering
A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about? Sublingual-swallow immunotherapy (SLIT) Desensitization Sublingual-topical immunotherapy (STIT) Resensitization
Desensitization Explanation: Desensitization is another option. Desensitization is a form of immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen without interruption. SLIT is a form of desensitization therapy. Options C and D are distractors for this question.
Which of the following is a mast cell stabilizer used in the treatment of allergic rhinitis? Intranasal cromolyn sodium (NasalCrom) Tetrahydrozoline hydrochloride (Visine) Pseudoephedrine hydrochloride (Sudafed) Oxymetazoline hydrochloride (Afrin)
Intranasal cromolyn sodium (NasalCrom)
A patient was seen in the clinic for hypertension and received a prescription for a new antihypertensive medication. The patient arrived in the emergency department a few hours after taking the medication with severe angioedema. What medication prescribed may be responsible for the reaction? Beta blocker Vasodilator Angiotensin-converting enzyme (ACE) inhibitor Angiotensin receptor blocker
Angiotensin-converting enzyme (ACE) inhibitor
A patient has had a "stuffy nose" and obtained Afrin nasal spray. What education should the nurse provide to the patient in order to prevent "rebound congestion"? a)Use the medication every 4 hours to prevent congestion from recurring. b)Drink plenty of fluids. c)Be sure to use the Afrin for at least 10 days to ensure the stuffiness is gone. d)Only use the Afrin for 3 to 4 days once every 12 hours.
Only use the Afrin for 3 to 4 days once every 12 hours. Explanation: Adrenergic agents, which are vasoconstrictors of mucosal vessels, are used topically in nasal (Afrin) and ophthalmic (Alphagan P) formulations in addition to the oral route (pseudoephedrine [Sudafed]) (Karch, 2012). The topical route (drops and sprays) causes fewer side effects than oral administration; however, the use of drops and sprays should be limited to a few days to avoid rebound congestion.
The nurse working in an allergy clinic is preparing to administer skin testing to a patient. Which of the following routes is the safest for the nurse to use to administer the solution? Subcutaneous Intramuscular Intravenous Intradermal
Intradermal Explanation: The intradermal route is the correct route of administration for skin testing and therefore a safe route. Another safe route is epicutaneous. The type of skin testing being performed determines whether the nurse will administer the solution via the epicutaneous or intradermal route.
The clinic nurse is caring for a client with an allergic disorder who has received the first sensitizing dose of a new drug. Now, the client is given a second dose. What nursing action is most important at this stage of transition? a)Assess the client for reduced urine output. b)Monitor the client for reactions. c)Assess the client for reduced appetite. d)Monitor the client for increased heart rate.
Monitor the client for reactions. Explanation: Monitoring the client is necessary when a second dose of a new drug is administered because reactions may follow the first sensitizing dose. Although it is important to ensure the client's comfort, it is not essential to assess the client for changes in urine output, appetite, or heart rate.
A client has been taking a decongestant for allergic rhinitis. During a follow-up visit, which finding suggests that the decongestant has been effective? a)Increased tearing b)Headache c)Reduced sneezing d)Increased salivation
Reduced sneezing Explanation: Decongestants relieve congestion and sneezing and reduce labored respirations. When effective, decongestants dry the mucous membranes; therefore, the client shouldn't experience increased salivation or tearing. Because decongestants alleviate congestion, they also relieve headaches, which may be caused by congestion.
A client comes to the clinic reporting nasal congestion and states, "I've been using an over-the-counter nasal spray that seemed to help at first, but then I got even more congested than before I started the medication. I continued the nasal spray, but it seems to be worse." The nurse suspects which of the following? Tolerance to the medication Drug overdose Development of a new allergy Rhinitis medicamentosa
Rhinitis medicamentosa
According to nursing research by Campbell et al., about 65% of patients identified with anaphylaxis who were seen in the emergency department were discharged to home. Of those 65%, one-third were prescribed self-injectable epinephrine. Patient teaching for use of an EpiPen must be included with discharge instructions. Select all the teaching points that apply. Grasp the EpiPen with the black tip pointing downward. Jab firmly at a 45 degree angle to get maximum penetration. Hold for 5 seconds and massage injection area for 5 seconds. Call 911 before injecting epinephrine. Form a fist around the unit. Hold black tip near outer thigh.
Grasp the EpiPen with the black tip pointing downward. Form a fist around the unit. Hold black tip near outer thigh.
After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first? Administer the antidote for penicillin, as ordered, and continue to monitor the client's vital signs. Insert an indwelling urinary catheter and begin to infuse I.V. fluids, as ordered. Administer epinephrine, as ordered, and prepare to intubate the client, if necessary. Page an anesthesiologist immediately and prepare to intubate the client.
Administer epinephrine, as ordered, and prepare to intubate the client, if necessary.
Atopic allergic disorders are characterized by which of the following? a)An IgA-mediated reaction b)A hereditary predisposition c)Production of a systemic reaction d)A response to physiologic allergens
A hereditary predisposition Explanation: Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens. Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens. Atopic and nonatopic allergic disorders are IgE-mediated allergic reactions
The nurse is educating a patient with allergic rhinitis about how the condition is induced. What should the nurse include in the education on this topic? Airborne pollens or molds Topical creams or ointments Ingested foods Parenteral medications
Airborne pollens or molds
A client with allergic rhinitis is prescribed a mast cell stabilizer. Which of the following would the nurse expect to be used? Diphenhydramine Cromolyn sodium Certirizine Zafirlukast
Cromolyn sodium
Which of the following is the most frequent route of exposure to a latex allergy? a)Parenteral b)Inhalation c)Cutaneous d)Mucosal
Cutaneous Explanation: Routes of exposure to latex products can be cutaneous, percutaneous, mucosal, parenteral, or aerosol. Allergic reactions are more likely with parenteral or mucous membrane exposure but can also occur with cutaneous contact or inhalation. The most frequent source of exposure is cutaneous, which usually involves the wearing of natural latex gloves.
When assessing the skin of a client with allergic contact dermatitis, the nurse would most likley expect to find irritation at which area? Plantar aspects of the feet Lower arms Ankles Dorsal aspect of the hand
Dorsal aspect of the hand
When a patient experiences an allergic reaction, the nurse should initially assess for:
Dyspnea, bronchospasm, and/or laryngeal edema. Explanation: Initial nursing assessment and intervention needs to be directed toward evaluating breathing and maintaining an open airway.
A health care provider prescribed Flonase, an intranasal corticosteroid, for a patient with a severe case of allergic rhinitis. The nurse told the patient that there is a delayed response to full benefits from the drug. The patient took his first dose on February 2. The patient should expect that the drug will be fully effective no later than: February 12. February 9. February 15. February 6.
February 15.
Which of the following terms refers to an incomplete antigen? Allergen Antibody Hapten Antigen
Hapten Explanation: A hapten is an incomplete antigen. An allergen is a substance that causes manifestations of allergy. An antigen is a substance that induces the production of antibodies. An antibody is a protein substance developed by the body in response to and interacting with a specific antigen.
A nurse is reviewing the dietary history of a client who has experienced anaphylaxis. Which of the following would the nurse identify as a common cause of anaplhylaxis? Select all that apply? Shrimp Chicken Beef Eggs Milk
Milk Eggs Shrimp
A 6-year-old experienced an allergic reaction to shellfish. The nurse practitioner gave the mother a booklet that includes teaching points about food allergies. The nurse reminded the mother to be vigilant for mild systemic reactions such as: Wheezing and coughing. Nasal congestion and sneezing. Shortness of breath. Bronchospasm.
Nasal congestion and sneezing.
Which of the following allergies is responsible for most severe food allergy reactions? Seafood Berries Peanuts Seeds
Peanuts
The nurse working in the ED is asked to explain allergy testing to a patient who experienced an allergic reaction to an unknown allergen. Which test indicates the quantity of allergen necessary to evoke an allergic reaction? Intradermal test Provocative testing RAST Scratch test
RAST Explanation: RAST is a radioimmunoassay that measures allergen-specific IgE. The RAST indicates the quantity of allergen necessary to evoke an allergic reaction. Provocative testing involves the direct administration of the suspected allergen to the sensitive tissue, such as the conjunctiva. The scratch test does not indicate the quantity of allergen.
A patient asks the nurse if it would be all right to take an over-the-counter antihistamine for the treatment of a rash. What should the nurse educate the patient is a major side effect of antihistamines? Sedation Palpitations Anorexia Diarrhea
Sedation
What is the most common cause of anaphylaxis? a)NSAIDs b)Radiocontrast agent c)Penicillin d)Opioids
Penicillin Explanation: Penicillin is the most common cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States each year. Opioids, NSAIDs, and radiocontrast agents are some of the medications that are frequently reported as causing anaphylaxis.
The nurse is evaluating the plan of care for a client with an allergic disorder who has a nursing diagnosis of deficient knowledge related to measures for allergy control. Which of the following would indicate to the nurse that the outcome has been met? Client demonstrates appropriate coping strategies for dealing with a chronic disorder. Client identifies methods for reducing exposure risk to allergens. Client states the need for coughing and deep breathing. Client reports an absence of symptoms associated with the allergy.
Client identifies methods for reducing exposure risk to allergens. Explanation: For the nursing diagnosis of deficient knowledge, the client's ability to identify methods for reducing the risk of allergen exposure indicates that the outcome has been met. The statment about coughing and deep breathing and an absence of symptoms would be appropriate for evaluating the nursing diagnosis of ineffective breathing pattern. Positive coping strategies would be an appropriate outcome for a nursing diagnosis of ineffective coping.
An infant is born to a mother who had no prenatal care during her pregnancy. What type of hypersensitivity reaction does the nurse understand may have occurred? a)Bacterial endocarditis b)Rh-hemolytic disease c)Lupus erythematosus d) Rheumatoid arthritis
Rh-hemolytic disease Explanation: A type II hypersensitivity, or cytotoxic, reaction, which involves binding either the IgG or IgM antibody to a cell-bound antigen, may lead to eventual cell and tissue damage. The reaction is the result of mistaken identity when the system identifies a normal constituent of the body as foreign and activates the complement cascade. Examples of type II reactions are myasthenia gravis, Goodpasture syndrome, pernicious anemia, hemolytic disease of the newborn, transfusion reaction, and thrombocytopenia.
The nurse is evaluating a patient's complete blood cell count and differential (CBC and diff) along with the serum immunoglobulin E (IgE) level. Which of the following results might indicate that the patient has an allergic disorder? a)Low white blood cells b) Low eosinophil level c) High neutrophils d) High IgE level
High IgE level Explanation: High total IgE levels and/or a high percentage of eosinophils may indicate an allergic disorder. However, normal IgE levels do not exclude the diagnosis of an allergic disorder. The level of neutrophils and white blood cell counts are not impacted by allergic disorders.
Which of the following is a primary chemical mediator of hypersensitivity? a)Serotonin b)Histamine c)Heparin d)Bradykinin
Histamine Explanation: Histamine is a primary chemical mediator of hypersensitivity. Secondary mediators include serotonin, heparin, and bradykinin.
A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? a)IgG b)IgE c)IgA d)IgB
IgE Explanation: Immunoglobulin E (IgE) is involved with an allergic reaction. IgA combines with antigens and activates complement. IgB coats the surface of B lymphocytes. IgG is the principal immunoglobulin formed in response to most infectious agents
There are several types of reactions to latex. The nurse knows to be most concerned about laryngeal edema with the following reaction: Allergic contact. IgG antibodies. Irritant contact. IgE-mediated hypersensitivity.
IgE-mediated hypersensitivity.